The radiological

methods of the

gastrointestinal system

examination

The main methods of

examination

- Roentgenoscopy (fluoroscopy)

- Roentgenography

- Fluorography

The additional methods

- Roentgen polygraphy

- Roentgen kymography

- Tomography

- Roentgenoscopy with primary

magnification

The special contrast methods

- Double contrasting

- Pneumoparietography of the stomach

The roentgen anatomy and

examination of esophagus

- Width – from 1,5-2 см to 2 см;

- Length – 25-26 см;

- The parts of esophagus:

А) cervical;

Б) thoracic;

В) abdominal.

- Three physiologic narrowings:

А) at the level of cricoid cartilage;

Б) at the level of aortic arc;

В) at the level of cardia.

- The folds of mucosa – 2-3 см, parallel,

longitudinal;

- The velocity of contrast movement

is 4-6 sec.

folds

peristalsis

narrowing (arc)

cardia

The roentgen anatomy and

examination of the stomach

1. The survey roentgenoscopy.

2. The first stage of examination – the

patient drinks 1-2 swallows of contrast

(we can evaluate the folds of mucosa of

the stomach).

3. The second stage of examination –

tight filling. We can determine the

shape, size and position of stomach.

4. The stomach peristalsis:

- Superficial;

- Medium depth;

- Deep;

- Segmental;

- The velocity of peristaltic wave is 21 sec.

trendelenburg

Double contrasting

parietography

5. Parts of the stomach:

- Fundus;

- Cardiac part;

- Body;

- Sinus (or angle);

- Antrum;

- Pyloric part;

- Minor and major curvature.

The roentgen anatomy and

examination of duodenum and

small intestine

1. The duodenum comes after stomach

and it has three parts:

- Superior (bulb of triangular shape);

- Descending (covers the head of

pancreas);

- Inferior.

2. Small intestine:

- duodenum;

- jejunum;

- ileum;

- Kerckring's folds of the mucosal layer.

N

The roentgen anatomy and

examination of large intestine

1. The methods of examination:

- Per os;

- Irrigoscopy – contrast enema.

2. Roentgen anatomy and parts of the

large intestine:

- Caecum;

- C. ascendens;

- C. transversum;

- C. descendens;

- C. sygmoideum;

- Rectum.

3. Irrigoscopy:

- The first stage of examination – tight filling of the bowel.

А) shape;

Б) size;

В) localization.

- The second stage of examination– the evaluation of the mucosa folds (after depletion of patient);

- The third stage of examination– double contrasting (inflation of large intestine with barium sulfate by Bobrov device). The elasticity of the walls is determined.

N

The pathology of the

gastrointestinal tract

1. Esophagus:

- Esophageal diverticuli:

А) pulsational;

Б) tractional;

В) functional.

- Achalasia of esophagus;

Balon dilatation

Achalasia beforeafter

- Cancer of esophagus:

А) scirrhous;

Б) bowl-shaped (saucer-shaped);

В) medullar shape.

The symptoms of cancer:

- Stenosis of esophagus;

- Filling defect;

- Irregular borders;

- The delay of contrast media above the

level of stenosis;

- Deformation and absence of the folds;

- The absence of peristalsis at the level of

defect.

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cr

- Burn of esophagus:

The first examination is possible after 2-3 weeks.

Symptoms:

• Circular stenosis;

• Flat contours;

• Deformation – cone-, funnel-, ampullar.

- Foreign substances

Method by Ivanova-Podobed.

burn

2. Stomach:

- Gastritis:

А) acute;

Б) chronic;

В) chronic hyperthrophic gastritis;

Г) rigid antral gastritis.

- The ulcer of stomach and duodenum:

Symptoms:

• “niche”;

• inflammative elevation of mucosa;

• folds convergention;

• the symptom of “pointing finger”.

Complications:

• hemorrhage;

• perforation;

• penetration;

• malignisation (transformation into cancer).

Acute ulcer

Chronic ulcer

ulcus

ulcus

ulcus

- Cancer of stomach:

• polypous;

• bowl-shape;

• ulcerative cancer;

• diffuse;

• cancerous ulcer;

• cancer from polyp.

Symptoms:

• filling defect;

• the absence of the folds of mucosa;

• the absence of peristalsis at the defect

localization;

• stenosis of the lumen.

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polyposis

Malignant polyps of stomach

3. Large intestine:

- Inflammations:

А) colitis;

Б) chronic colitis;

В) chronic spastic colitis;

Г) unspecific ulcerative colitis.

Symptoms:

• spasm of intestine;

• smoothness of haustrum;

• smoothness of the folds of mucosa.

colitis

artefact

n

- Cancer of the large intestine

Symptoms:

• filling defect;

• irregular contours;

• circular stenosis;

• the absence of the folds of mucosa;

• evacuation disorders.

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The roentgenologic picture of

the acute abdomen

1. Bowel obstruction.

- high;

- low.

Symptoms:

- Kloyber cups(at the background of

swallen bowel there is the presence of

horisontal level of fluid).

B. obstruction

2. Perforate ulcer.

- Symptom of sickle (the presence of air

under the right cupola of the diaphragm).